1. Technical Field
The present disclosure relates to a method for transmyocardial revascularization (TMR) and apparatus for implementing the same.
2. Background of the Related Art
TMR is a known procedure for producing channels of small diameters within the myocardium, which channels extend into the ventricle. Such channels are believed to facilitate delivery of blood directly from the ventricle to oxygen starved areas of the heart. TMR is typically used on patients with ischemic heart disease who are not candidates for coronary artery bypass or percutaneous transluminal angioplasty.
During a TMR procedure, typically dozens of channels are created from the epicardium, through the myocardium and endocardium and into the ventricle, with each channel being of sufficiently small diameter such that the end portions of the channels at the epicardium can be closed by blood clotting. The channels are preferably created by employing either a mechanical coring apparatus or an advancing lasing device. With either technique, an important objective is to produce channels that remain patent in the long term and which do not close up due to fibrosis and/or scarring.
With traditional TMR procedures, a technique for stopping the bleeding from each channel at the epicardium after channel formation entails applying pressure to the opening of the just-formed channel. Pressure is typically applied by the finger of the surgeon or assistant during open heart surgery, or with an endoscopic instrument when the procedure is performed endoscopically. In either case, since pressure is applied to each channel opening for at least several seconds, and it is impractical to begin forming another channel until the bleeding is stopped from the previous channel, the overall TMR procedure wherein typically dozens of channels are formed is undesirably prolonged by the time expended on applying pressure to each channel.
Accordingly, a need exists for a TMR procedure wherein the time spent to stop the blood flow from each of the individual transmyocardial channels is reduced or eliminated and the channels are prevented from closing, thereby increasing the likelihood of success of each operation and saving lives.
A need also exists to provide cost effective instruments for performing TMR.